# BOLD PEDIATRIC THERAPY CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366964538
- **Authorized official:** DR. SANDRA PELHAM-FOSTER OTD, MPHA, OTR/L (DIRECTOR /OWNER)
- **Authorized official phone:** (503) 313-7333

## Contact information

- **Practice address:** 1815 NW 169TH PL STE 3070, BEAVERTON, OR 97006-7368
- **Practice address phone:** (971) 249-2653
- **Mailing address:** 409 NE BIRCHWOOD TER, HILLSBORO, OR 97124-3219
- **Mailing address phone:** 15033137333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | OR | Yes |

## Other

- **Enumeration date:** 07/10/2017
- **Last updated:** 07/10/2017